| Wk Medical Group | |
|
2542 S Bascom Ave Ste 110 Campbell CA 95008-5526 | |
| (408) 559-3403 | |
| Not Available |
| Full Name | Wk Medical Group |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2542 S Bascom Ave, Campbell, California |
| Authorized Official Name and Position | Bruce Melvin Wermuth (PRESIDENT) |
| Authorized Official Contact | 4085593403 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Medical Group 2542 S Bascom Ave Ste 110 Campbell CA 95008-5526 Ph: (408) 559-3403 | Wk Medical Group 2542 S Bascom Ave Ste 110 Campbell CA 95008-5526 Ph: (408) 559-3403 |
| NPI Number | 1588083992 |
|---|---|
| Provider Enumeration Date | 04/14/2014 |
| Last Update Date | 06/16/2020 |
| Certification Date | 06/16/2020 |
| Medicare PECOS PAC ID | 6103116348 |
|---|---|
| Medicare Enrollment ID | O20160601000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588083992 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G25581 (California) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | G25581 (California) | Primary |
| Provider Name | Tirath Gill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639260292 PECOS PAC ID: 6204723844 Enrollment ID: I20040301000110 |
| Provider Name | Bruce M Wermuth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629104617 PECOS PAC ID: 0749267540 Enrollment ID: I20040707000650 |
| Provider Name | Shamala Vasant Kanchan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245331495 PECOS PAC ID: 7214118041 Enrollment ID: I20110225000712 |
| Provider Name | Yuriy Dobry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245558881 PECOS PAC ID: 1355570458 Enrollment ID: I20140213001028 |
| Provider Name | Jeremy J Kernion |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902101678 PECOS PAC ID: 3779800677 Enrollment ID: I20150401002107 |
| Provider Name | Rajan Gosain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013271600 PECOS PAC ID: 8426341033 Enrollment ID: I20161205002176 |
| Provider Name | Stephanne Pleshette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528091576 PECOS PAC ID: 0547276198 Enrollment ID: I20170623001312 |
| Provider Name | Ferhad Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831484930 PECOS PAC ID: 5395041685 Enrollment ID: I20180123003154 |
| Provider Name | Nataly Sumarriva Beck |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548672926 PECOS PAC ID: 8628361961 Enrollment ID: I20190903002989 |
| Provider Name | Emaka Takashima |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043460306 PECOS PAC ID: 0042642639 Enrollment ID: I20191120001660 |
| Provider Name | Kristina B Hart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437276680 PECOS PAC ID: 9335579325 Enrollment ID: I20200414003450 |
| Provider Name | Sridevi Banka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477199420 PECOS PAC ID: 6608296231 Enrollment ID: I20201020000791 |
| Provider Name | Shellyatta Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558809608 PECOS PAC ID: 8820405848 Enrollment ID: I20210318000811 |
| Provider Name | Srikanth Challagundla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902186737 PECOS PAC ID: 0446572796 Enrollment ID: I20221129001378 |
| Provider Name | Fides Isidro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427276013 PECOS PAC ID: 8325430937 Enrollment ID: I20240112003873 |
| Provider Name | Elinor Slayer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043713381 PECOS PAC ID: 0244679819 Enrollment ID: I20240415004032 |
| Provider Name | Angela Hickenbottom |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1679886279 PECOS PAC ID: 5395184576 Enrollment ID: I20240420000257 |
| Provider Name | Lucia Olson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1588825269 PECOS PAC ID: 6204275480 Enrollment ID: I20240420000263 |
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